Category Archives: Health Care

Virginia Community Schools Redefined – Part 2 – Stop Trying to Provide Mental Health Services in School

by James C. Sherlock

In Part 1 of this series I described the current Virginia Community School Framework (the Framework) and found it not only lacking, but counter-productive.

Its basic flaw is that it assumes all services to school children will be provided in the schools by school employees, including mental health services.

When you start there, you get nowhere very expensively, less competently, and with considerably more danger in the case of mental health than if the schools were to partner with other government and non-profit services.

This part of the series will deal with child and adolescent mental health services exclusively.

Public mental health, intellectual disability and substance abuse services for children and adolescents are funded by governments at every level. For the federal view of the system of care, see here.

In Virginia, those services are organized, overseen and funded through a state and local agency system.

  • The state agency is the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in the Secretariat of Health and Human Resources. The Department of Medical Assistance Services (DMAS) (Medicaid) plays a funding and patient management role as well;
  • Local agencies funded and overseen by DBHDS are the Community Services Boards (CSB’s) throughout the state.

Some schools and school systems seem to operate on a different planet from their local CSB’s. Indeed, the Framework mentions them only reluctantly and in passing.

The ed school establishment clearly wants to handle child and adolescent mental health problems in-house, with tragic results. They need to stop it now.

There is absolutely no need to wait. Continue reading

Virginia Community Schools Redefined – Hubs for Government and Not-for-Profit Services in Inner Cities – Part 1 – the Current Framework

by James C. Sherlock

I believe a major approach to address both education and health care in Virginia’s inner cities is available if we will define it right and use it right.

Community schools.

One issue. Virginia’s official version of community schools, the Virginia Community School Framework, (the Framework) is fatally flawed.

The approach successful elsewhere brings government professional healthcare and social services and not-for-profit healthcare assets simultaneously to the schools and to the surrounding communities at a location centered around existing schools.

That model is a government and private not-for-profit services hub centered around schools in communities that need a lot of both. Lots of other goals fall into place and efficiencies are realized for both the community and the service providers if that is the approach.

That is not what Virginia has done in its 2019 Framework.

The rest of government and the not-for-profit sector are ignored and Virginia public schools are designed there to be increasingly responsible for things that they are not competent to do.

To see why, we only need to review the lists of persons who made up both the Advisory Committee and the Additional Contributors. Full of Ed.Ds and Ph.D’s in education, there was not a single person on either list with a job or career outside the field of education. Continue reading

Another Price Virginia Pays for Certificate of Public Need – Mediocrity in Cancer Treatment

NYC’s Memorial Sloan Kettering (MSK) has ranked in the top two “Best Hospitals for Cancer” every year since U.S. News & World Report began rating hospitals in 1990.

by James C. Sherlock

In an article titled “60 hospitals and health systems with great oncology programs headed into 2023,” Becker’s Hospital Review gives us a glimpse of one of the greatest costs of Virginia’s decades-long Certificate of Public Need (COPN) program.

The hospitals and health systems featured on this list have earned recognition nationally as top cancer care providers and many are on the cutting edge of novel therapies and researcher to improve outcomes and access to care.

The hospitals and health systems below are among the vanguard of cancer treatment and research in the country. Many of them have earned National Cancer Institute comprehensive cancer center designation and are ranked among the top hospitals for cancer care by U.S. News & World Report.

The list also features cancer centers with busy research institutes, multiple clinical trials and safety designations that exceed national benchmarks.

Hospitals and health systems listed below are dedicated to expanding their oncology departments and regional cancer centers to improve patient care locally and nationally. We accepted nominations for this list. Click here to find the 2023 nomination forms.

Sixty leading cancer programs. Not one of them is in Virginia, the 12th largest state. What we get, to be blunt, is state-sponsored and state-protected mediocrity among the nation’s hospitals in that specialty.

Central planning and lack of competition will produce that result. OK at a lot of things, the best at nothing.

If you want in on a clinical trial, Virginia is not the state in which to look for one.

Look at your leisure at COPN rules.

You will find no exception for excellence. Continue reading

Parents’ Rights Under Assault in Richmond

by Kerry Dougherty


Parental access to minor’s medical records; consent by certain minors to treatment of mental or emotional disorder. Adds an exception to the right of parental access to a minor child’s health records if the furnishing to or review by the requesting parent of such health records would be reasonably likely deter the minor from seeking care. Under the bill, a minor 16 years of age or older who is determined by a health care provider to be mature and capable of giving informed consent shall be deemed an adult for the purpose of giving consent to treatment of a mental or emotional disorder. The bill provides that the capacity of a minor to consent to treatment of a mental or emotional disorder does not include the capacity to (i) refuse treatment for a mental or emotional disorder for which a parent, guardian, or custodian of the minor has given consent or (ii) if the minor is under 16 years of age, consent to the use of prescription medications to treat a mental or emotional disorder.

Parental rights continue to be under assault by Democrats in the General Assembly. They will never give this up until they are all voted out of office.

Fortunately, the GOP majority in the House of Delegates will be able to kill HB2091, a bill that would create an avenue for “health care providers” to keep information and treatment of mental or emotional disorders secret from parents.

We all know what “mental and emotional disorders” are code for: transgenderism and other associated behaviors. Continue reading

General Assembly Democrat Bill Supports Gender Transition at 16 Without Parental Consent

Del. Candi King, (D) – House District 2 Stafford and Prince William (Facebook)

by James C. Sherlock

I note that House Bill No. 2091, with Patrons Munden-King, Clark, Hope, Maldonado, Rasoul and Simon does two things:

  1. It modifies Code of Virginia § 20-124.6. Access to minor’s records to permit health care providers to deny a minor patient’s records to parents if, in the provider’s judgment, providing those records would be “reasonably likely to deter the minor from seeking care.”
  2. It modifies Code of Virginia § 54.1-2969. Authority to consent to surgical and medical treatment of certain minors by adding:

“L. Any minor 16 years of age or older who is determined by a health care provider to be mature and capable of giving informed consent shall be deemed an adult for the purpose of giving consent to consultation, diagnosis, and treatment of a mental or emotional disorder by a health care provider or clinic.”

“Deemed by a health care provider.”

Going out on a limb, let’s take gender dysphoria as an example. Continue reading

Virginia’s Four Largest Not-for-Profit Health Systems and Medically Underserved Areas Next to their Headquarters

by James C. Sherlock

A challenge to Virginia’s largest not-for-profit health systems: just do it.

Take the lead.

Note the medically underserved areas (MUAs) next to your headquarters and flagship hospitals and provide primary care in those locations.

Virginia has federally-designated MUAs in Arlandria (INOVA), Norfolk (Sentara), Roanoke (Carilion) and Lynchburg (Centra). Those health systems are each headquartered in those cities.

  1. Arlandria is four miles from INOVA Alexandria Hospital. It was just designated in 2022.
  2. The medically underserved census tracts in Norfolk (pictured above) are closer than that to Sentara’s flagship Norfolk General Hospital. Those are just the worst of them. Eight more Norfolk census tracts made the list. Pretty much every poor area of the city. I got tired of outlining them. But you get the idea. Originally designated in 1994. Updated in 2009.
  3. Carilion Roanoke Community Hospital is right at the edge of that city’s underserved tracts. Originally designated in 1998. Updated in 2012.
  4. Underserved areas in east Lynchburg are in the service area of Centra’s flagship Lynchburg General Hospital. Designated in 1994. Updated in 2011.

The leadership of those health systems drive through those areas on the way to work.

Not-for-profit health systems conduct community health needs assessments (CHNA) once every three years to meet federal and state requirements. The CHNAs of those four health systems have recognized that those areas are underserved in primary care for a very long time.

Time for them to take the lead to provide primary care in communities a bicycle ride from their headquarters and major hospital facilities.

Then as a state we can move forward into more challenging areas. Continue reading

Virginia Medically Underserved Areas for General Assembly Consideration

by James C. Sherlock

We have a new General Assembly session. With that comes lots of healthcare bills.

I will not examine each one, but I have a suggestion for criteria to be applied by the Senate and House committees that do.

Ask yourselves how, if at all, each bill helps the federally designated medically underserved areas (MUAs) in Virginia.

Then ask how can any bill be a priority for funding ahead of those that do help that problem.

Then remember that providing primary care to underserved areas is proven to save a ton of Medicaid money net where it has been tried, as in Maryland, because of inpatient care avoidance.

Then ask the not-for-profit health systems that serve those areas to testify how, exactly, they can be medically underserved when that is what the health system tax exemptions are meant to prevent, and free cash flows have been extraordinary for decades.

And, finally, if you have no bills that help provide additional primary care to those areas, you aren’t doing it right. Continue reading

Has COVID Already Peaked for Winter 2023?

Screen capture from Virginia Department of Health website, using Virginia Hospital and Healthcare Association data. Click for larger view.

Last year in Virginia, the COVID-19 hospital count hit its winter season peak on January 12 at more than 3,700 beds occupied. Now the 7-day average is below 1.100, and Thursday’s daily count (reported Friday) dropped below 1,000 to 990. The most recent peak was Jan. 4. Flu and RSV are also on the wane, only a handful of weeks after the media scarecrows ran story after story of the coming triple-demic disaster. Being sick remains something to avoid, and the vulnerable can still die from any one of the three (or a combination, shudder). I personally give most of the credit to the vaccinations, especially among the elderly or vulnerable. Those who have actively sought to discourage them should be ashamed of themselves, but the nonsense remains rampant.

(Update:  The hospital count as of Jan. 16 is now down to 905.  The decline has lasted almost two weeks.)

Why Law Enforcement Supports Gov. Youngkin’s Behavioral Health Transformation

Virginia Beach Sheriff’s Deputies

by James C. Sherlock

Updated Jan 6 at 13:10.

Virginia’s sheriffs and police chiefs are reasonably hardened by what they see every day.

They have very difficult jobs to do and are unlikely, either individually or in groups, to support nonsense.

Governor Glenn Youngkin has accepted the challenge of finally fixing Virginia’s behavioral health system. He is strongly supported in that effort by Virginia’s sheriffs and police chiefs.

This is a straightforward proposition for law enforcement.

  • They want people with mental health crises treated by professionals before they commit crimes, not after; and
  • They want them housed when necessary in facilities appropriate to the task of treating them, not in jails.

The Governor proposes to spend $341.6 million in the next fiscal year on that problem, including $123 million in new funding.

  • The law enforcement community sees that as a bargain.
  • Neither the Governor nor law enforcement are known to put up with failure.

The case is sufficiently compelling for small government conservatives to back this effort. Continue reading

Democrats Want to Raise Youngkin-Proposed Mental Health Budget Increase

Health Resources and Services Administration Mental Health Care Health Professional Shortage Areas, by State, as of September 30, 2022, data.HRSA.go.                 Courtesy Governor Youngkin

by James C. Sherlock

There is fundamental agreement in Richmond over mental health services.

From the Richmond Times-Dispatch:

Virginia’s forecasts of long-term budget surpluses mean this year’s General Assembly has a chance to catch up with years of under-funding Virginia schools and the state’s behavioral health system, General Assembly Democrats say.

To govern is to choose. “Democrats” may wish they had used different words than “years of underfunding,” considering who had control in Richmond in 2020 and 2021.

But it is actually helpful that they now think even the governor’s proposal for a 20% increase in the mental health budget approved last year is not enough. If (a big if) more money can be spent efficiently and effectively.

The governor has proposed a $230 million increase in behavioral health program spending over what was approved last year.

So, as the old saying goes, they are just discussing price.

Let’s look at the behavioral health situation to see why. Continue reading

Preparing for the Costs to Government of Virginia’s Generation COVID

John Littel, Virginia Secretary of Health and Human Resources

by James C. Sherlock

To justify her insistence on keeping schools closed, Randi Weingarten, the president of the American Federation of Teachers, said in February of 2021, “kids are resilient and kids will recover.”

She brought that same message to Virginia.

In one of the strangest choices in Virginia political history, Terry McAuliffe brought Weingarten to Virginia to campaign with him on the last weekend of his losing gubernatorial campaign.

Thus sealing his defeat.

It turns out, as it was always going to, that you can’t keep kids out of school for up to a year and a quarter, homebound, and expect all of them to “recover.”

I will call here those in K-12 during COVID school shutdowns Generation COVID (Gen C).

I wrote the other day of an estimate by a renowned educational economist that the 1.2 million Gen C kids in Virginia public schools would lose several hundred billion dollars in lifetime earnings because of un-repaired damages to their learning of all types.

His critics here argued into the night about study methodology, but none denied costs at some level would be there. They did not offer their own estimates.

John Littel, Virginia’s Secretary of Health and Human Resources, has the job of preparing his agencies for the lifetime social costs of those children. Continue reading

Medicare Care Compare – The Only Way to Find the Best Home Health Services in Your Area

The Medicare Compare Lady. Courtesy CMS.

by James C. Sherlock

I have been using Medicare Care Compare ratings in my research and writing for 15 years.

Regular readers are familiar with my work on hospitals. I published in this space an extensive series on Virginia nursing homes. For quality ratings and consumer survey data, there is absolutely no substitute for Medicare Care Compare.

This article is about home health services.

There are other rating “services.” Ignore them. None has the timeliness or volume of objective data available on Medicare Care Compare.

The Centers for Medicare & Medicaid Services (CMS) has built the Care Compare website as a decision aid. I find it to be the easy-to-access, convenient and up-to-date official source of information about provider quality that CMS intends. It gets better all the time.

This website displays for Medicare-certified home health agencies both data compared to national and state norms and star ratings for:

  1. clinical measures compiled from the Outcome and Assessment Information Set (OASIS) Prospective Payment System (PPS); and
  2. the results from the Home Health Consumer Assessment of Healthcare Providers & Systems (HHCAHPS) surveys.

Results are based on data from the last four quarters and are updated each quarter.

CMS assigns weights to each measure, calculates the results, adjusts for patient mix, and awards quality and consumer stars on a Bell curve. Across the country, most agencies fall in the middle with 3 or 3½ stars.

It represents a very tough cut. Which is what makes it so useful.

  • You will find 240 Medicare-certified home health agencies in Virginia;

Continue reading

Public Education and the Management of Change

Freedom High Woodbridge

by James C. Sherlock

Peter Drucker’s famous five questions should always be asked by and of government.

What is the mission? Who is the customer? What does the customer consider valuable? What are the results sought and how are they to be measured? What is the plan, to include both abandonment and innovation?

So, in reviewing the 119-page JLARC report Pandemic Impact on Public K–12 Education 2022, we must inquire first what JLARC was asked to do by the General Assembly.

Then examine what they did with that charter.

Both were well intentioned but incomplete. Continue reading

Student Mental Health Crisis Explained – By The Washington Post

Freedom High Woodbridge

by James C. Sherlock

The Washington Post, in a lengthy article, “The crisis of student mental health is much vaster than we realize,” wrote about the mental health crisis facing our school children, especially adolescents.

Nationally, adolescent depression and anxiety — already at crisis levels before the pandemic — have surged amid the isolation, disruption and hardship of covid-19.

Now, the Post tells us. They even hint that more federal money may not help. Which must have taken an extra couple of days of meetings before publication.

The article did not identify the “we” who were cited in the headline as not realizing this was happening. Who indeed could have guessed such an outcome?

Other than anyone older than 12 not blinded by a “narrative” that never included the children’s mental health.

Some even wrote about the issues when recommending that kids go back to school in person. Before the start of the 2020-21 school year.

In the Post story, not a word about the “leaders” in state and local governments and the teachers union strike threats that kept some Virginia public schools closed up to an extra year.

Not a word about the Catholic schools that opened across the state in the fall of 2020.

Not a word of apology for being a big part of the problem that needs to be fixed. Continue reading

Richmond Community Hospital: Poster Child for Reforming 340B

By Dr. William S. Smith
and Chris Braunlich

Nonprofit hospitals in low-income neighborhoods should be the backbone of the American safety net system for low-income people who lack insurance. Instead, thanks to a federal program called 340B, many nonprofit hospitals have made maximizing revenue their primary goal, not providing charity care. Thanks to a New York Times investigation, Richmond Community Hospital has become the starkest example of a nonprofit hospital that exploits the 340B program while reducing medical services available to the distressed community surrounding the hospital.

The 340B program was created by Congress in 1992 and was intended to allow about 500 hospitals in low-income areas to purchase drugs at substantial discounts. It was thought that, with these discounts, nonprofit hospitals could provide more free care to the distressed communities where they were located.

However, the law was poorly written, and hospitals soon discovered that they could “arbitrage” these drug discounts into a profit center. How could they do this? In short, buy low and sell high. As The New York Times story explained, Richmond Community can buy a vial of the cancer drug Keytruda at a discounted price of $3,444, yet can bill the local Blue Cross health plan $25,425 for that same vial, for a profit of $22,000 on one patient’s prescription. Continue reading